INSURE技术防治新生儿呼吸窘迫综合征的临床研究

目的通过与传统气管插管机械通气(mechanical ventilation,MV)比较,分析气管插管-肺表面活性物质-拔管使用持续气道正压通气(INtubate-SURfactant-Extubate to CPAP,INSURE)技术防治新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)的作用。方法回顾性分析2011年1月-2012年12月采用INSURE技术(INSURE组)或机械通气(MV组)治疗的127例NRDS患儿,比较两组患儿早期结局(二次使用PS、肺出血、气漏综合症、PPHN、PDA)、晚期结局(BPD、ROP、IVH、PVL);与感染相关并发症(败血症、NEC);预后。结果 1)两组患儿一般情况具有可比性(P0.05);2)早期结局:INSURE组二次使用PS、肺出血、气漏综合症、PPHN均低于MV组(P0.05);3)感染相关并发症:败血症发生率更低(P值均0.05);4)晚期结局:INSURE组BPD、ROP、IVH(III级以上)及PVL与MV组比较差异无统计学意义(P0.05);5)预后:两组死亡率及治愈率差异无统计学意义(P0.05)。结论 INSURE技术能更好改善NRDS患儿早期结局,减少二次PS使用,降低肺出血、气漏综合症、PPHN发生;降低败血症的发生;缩短用氧时间;未增加BPD、ROP、IVH、PVL的发生率及死亡率。

Clinical study of INtubate-SURfactant-Extubate to CPAP method in the prevention and treatment for neonatal respiratory distress syndrome

Objective To investigate the effectiveness of INtubate-SURfactant-Extubate to CPAP (INSURE) method in premature infants with respiratory distress syndrome(NRDS). Methods A total of 127 prematures with NRDS from January 2011 to December 2012 were recruited,and data were collected retrospectively.Early outcomes(the PS repeatment,pneumorrhagia,air leak syndrome,PPHN,PDA),late outcome(BPD,ROP,IVH,PVL),complications related with infection(septicemia,NEC) as well as prognosis were compared between two groups. Results There was no statistically difference in general conditions between two groups (P>0.05).The second PS need,pneumorrhagia and air leak syndrome as well as PPHN were significantly decreased in INSURE group (P<0.05).INSURE group had less cases with infectious diseases as septicemia (P<0.05).There was no statistically difference (P>0.05) in the late outcomes such as BPD,ROP,IVH and PVL between two groups.The prognosis such as cure rate and mortality showed no difference in two groups (P>0.05). Conclusions Compared with MV,INSURE can improve the early outcome of NRDS by alleviating NRDS severity,reducing the second PS need,decreasing pneumorrhagia,air leak symdrome and PPHN.It also lowers septicemia.It shorts the total oxygen therapy time,without increasing the occurance of BPD,ROP,IVH,PVL and the mortality.